A 6-year-old boy with Down syndrome is diagnosed to have acute appendicitis. Anesthesiologist may require the following investigation prior to general anesthesia:

Correct Answer: A

Rationale: Down syndrome has a ~50% incidence of congenital heart defects (e.g., AVSD), making an echocardiogram critical pre-anesthesia to assess cardiac risk (AAP guidelines). EKG is less specific for structural issues. Lateral neck x-ray checks atlantoaxial instability, but cardiac evaluation takes precedence. GI studies (D, E) are irrelevant here.

Correct Answer: D

Rationale: Anti-Ro IgG crosses the placenta, causing neonatal lupus (e.g., heart block) (NIAMS). IgM and IgA (B, C) don’t cross, and E is a misnomer.

Correct Answer: C

Rationale: Hungry bone syndrome follows parathyroidectomy , with rapid bone calcium uptake causing hypocalcemia (Endocrine Society). A-D don’t typically cause this.

Correct Answer: B

Rationale: Sympatholytics reduce heart rate, not increase it; A-D cause tachycardia (ACOG).

Correct Answer: D

Rationale: Above 10,000 mrad , risks to the fetus justify therapeutic abortion (ACOG). Lower doses (A-C) pose less risk, E is extreme.